Champion Of the Poor

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Farmer is, above all, a gifted clinician, and he developed in Haiti something he calls "the P.I.H. model," a formula for administering first-class health care in dirt-poor settings. Every AIDS or TB patient is assigned a paid health worker, or accompagnateur--generally a friend, relative or neighbor--who will handle the drugs and make sure they are taken on schedule. The patient is also given what the doctors hope will be enough food for a family of five. "You can't take these meds on an empty stomach," Farmer explains, "and you can't treat a wasting disease like AIDS or TB without calories." The extra rations are to avoid situations in which the sick have plenty to eat but their families starve.

The effectiveness of the model is evident when Farmer does checkups on AIDS patients after their first few weeks on ARVs. Hadija, 11, pretty in a pink dress, has gained nearly 7 lbs.; she shyly admits that her diarrhea has cleared up. Clementine, 35, a genocide widow with two children, has gained 9 lbs. but complains that pain from shingles makes it hard for her to work. Damascene, 14, has put on an astonishing 22 lbs., but Farmer senses that something's wrong; the boy's belly is distended with fluid. He gives the accompagnateur 2,000 francs (about $4) for transportation to return for further tests. The next day he drains Damascene's belly and diagnoses TB that has moved beyond the lungs. With proper treatment, says Farmer, the child will live long enough to have children of his own.

Partners in Health began enrolling AIDS patients in Rwanda in June and by last month was treating more than 300 with ARVs. It is on track to reach 1,000 by next spring--but that's just a fraction of the estimated 250,000 HIV-positive Rwandans who need food, housing, clean water and schools as well as medicine. The Global Fund subsidizes the drugs, but donors are reluctant to pay for the calories, arguing that food aid is never-ending and "unsustainable." Farmer, ever the optimist, is undismayed. "You start down this slippery slope," he says, "but it's a slippery slope that leads to better health care for poor people, so I say, Let's slide down it."

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